IMAGES IN EMERGENCY MEDICINE
Coital paraphimosis causing penile necrosis
1 Department of Surgery, Bronx Lebanon Hospital Center, Bronx, New York 10457, USA
2 Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605008, India
Correspondence to:
Dr S R Raman, MRCS, Department of Surgery, Bronx Lebanon Hospital Center, Bronx, New York 10457, USA; shankarrraman@gmail.com
| The first 150 words of the full text of this article appear below. |
A 60-year-old man presented with blackish discoloration of the glans penis for 2 days after sexual intercourse. He also complained of inability to reduce the foreskin to its normal position after retraction that occurred during coitus. On examination, he had paraphimosis and a necrotic patch over the glans (fig 1). Investigations ruled out systemic arterial disease as the cause of penile necrosis. The paraphimosis was reduced with gentle pressure. Excision of the necrotic patch resulted in satisfactory healing.
Figure 1 Paraphimotic ring with penile necrosis. Informed consent was obtained for publication of this figure.
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Paraphimosis is usually managed by gentle pressure reduction, ice packs, multiple punctures or by dorsal slit. Penile necrosis complicating paraphimosis has not been reported so far. A single case report mentioned near complete transection of the urethra as a result of chronic paraphimosis without gangrene, which was treated by partial amputation, although reconstruction was considered a
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